Healthcare Provider Details

I. General information

NPI: 1134671217
Provider Name (Legal Business Name): JULIANA LEIGH GLASER M.A. LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2016
Last Update Date: 10/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17326 EDWARDS RD STE 115
CERRITOS CA
90703-2444
US

IV. Provider business mailing address

17326 EDWARDS RD STE 115
CERRITOS CA
90703-2444
US

V. Phone/Fax

Practice location:
  • Phone: 877-538-4133
  • Fax:
Mailing address:
  • Phone: 877-538-4133
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number96201
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: